Management of premature rupture of membranes before 26 weeks' gestation

Abstract

PROM occurring before 26 weeks' gestation is associated with significant maternal morbidity as well as neonatal morbidity and mortality. With aggressive expectant management, neonatal survival can be predicted for a 23% and 54% incidence of patients with PROM at or less than 22 weeks' and 23 to 26 weeks' gestation, respectively. Of those neonates who survive, 55% to 69% will be neurologically intact on long-term follow-up. Conservative management leading to prolonged latency provides the neonate with the greatest potential for survival as outcome generally reflects the gestational age at birth. However, lethal pulmonary hypoplasia may occur with prolonged leakage and oligohydramnios. The patient who wishes to pursue a course of expectant management should be monitored closely for signs of infection and labor. Expectant management should be undertaken in a facility with resources capable of caring for the mother at risk of significant morbidity and the very low birth weight neonate. Ongoing counseling and psychologic support are essential in the management of this morbid pregnancy complication.